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Should my child have ACL Surgery?

ACL injury in child

ACL Tears in Children

ACL reconstruction surgery is the standard treatment for young, active people who sustain an ACL tear. But what happens when that person is a child? Should ACL surgery be delayed until the child is older, or should ACL reconstruction be performed before skeletal maturity?

Answer: Traditionally, when a child injured his anterior cruciate ligament (ACL), a connection within the knee important for joint stability, surgeons were reluctant to operate and reconstruct the ligament right away for fear of damaging the growth plate. The concern was that before a child has reached skeletal maturity (about 12-13 years old in girls or 14-15 years old in boys) this type of surgery presented a risk of injuring the growth plate. Growth plate problems resulting from ACL surgery could lead to unequal leg lengths or angular deformity. However, recent research shows that the risk of growth plate problems is much less then the risk of permanent knee damage if the ACL is not fixed.

Growth Plates in Children

The growth plates are the part of the bone that grows in length. Most bone growth occurs near to the ends of long bones in these areas called growth plates. Two of the most active growth plates in the body are just above and just below the knee joint. These growth plates contribute to the length of both the thigh bone (femur) and shin bone (tibia).Traditional ACL reconstructive surgery involves making a tunnel in the bone directly in the location of these growth plates. At the time of skeletal maturity, the growth plate closes. Once the growth plate is closed (or nearly closed) the risk of causing a growth disturbance is gone. However, by drilling a hole through an open growth plate, the body may close the growth plate early. This could lead to complete growth plate closure, causing leg length inequality, or partial growth plate closure, causing angular deformity. Angular deformity could in turn lead to knock knees (genu valgus) and bow legs (genu varus), These conditions progressively worsen with further growth and could lead to problems such as joint damage and arthritis.

ACL Tears in Children

Knees that are unstable as a result of ACL tears have a high chance of meniscus tears and cartilage injury. Many surgeons have recommended that ACL surgery in children be delayed until the child has reached skeletal maturity. The hope being that by delaying surgery, you could avoid the potential complications of growth plate injury as a result of ACL surgery.Two factors have lead to more surgeons recommending early ACL surgery, even in children. First, more recent research has evaluated the risk of growth plate injury in comparison to the downside of delaying surgical treatment of the torn ACL. The risk of meniscus tears and cartilage injury was found in a recent study to be higher than the risk of growth disturbances. Second, there are modifications to traditional ACL surgery that allow the growth plate to be minimally affected in children. Furthermore, your doctor may recommend a specific type of graft to help minimize the chance of growth plate injury if surgical treatment is pursued. Therefore, more surgeons are recommending early ACL surgery, even in children.

The bottom line is that the risks of waiting (joint instability, meniscus tears, and cartilage injury) appear to be greater than the risk of growth plate injury for early ACL reconstruction with current surgical approaches. As a result surgeons today are more likely to recommend early ACL reconstruction.

Back to Sports: Advance Knee Rehabilitation

Knee injury is one of the most common injuries sustained in sports. It can be in the form of meniscal or ligamentous  injury, the most notorious being the Anterior Cruciate Ligament (ACL) tear. As a result of such injuries, athletes of ten get frustrated as they are unable to perform as their best or even engage in the sport itself. More often than not, athletes do not manage their injuries well and many will attempt to return to sports much earlier than optimal and usually end up worse than before.

Bringing a competitive athlete from injury back to sports requires much more planning than just restoring range of motion and strength. It requires a good understanding of the healing processes, in depth knowledge of strength and conditioning as well as biomechanics of the body in relation to each sport, and the most important of all, the abiloty to implement the rehabilitation process systematically and appropriatelly. It is a science all to itself.

There are three phases in the rehabilitation process; healing and restoration phase, sports conditioning phase. Healing and restoration phase usually takes about four to six weeks and aims to get the athlete back to full range of motion and normal gait. Strength and conditioning phase takes another six to eight weeks with the aim of helping the athlete regain about 80% strength, and at the same time progressively improve their cardiovascular endurance. Finally, the sports conditioning phase aims to improve agility, balance, power and coordination. The phases are not distinct but overlap. With a thorough rehabilitation process, the athlete would be able to return to his sports with a firm foundation in all the key components of physical fitness, allowing him to ease into his sports training with confidence.

Healing and restoration phase (Week 0-4); Aims:

  • Reduce swelling and effusion to minimum
  • Restore normal gait pattern
  • The management of a knee immediately post-operatively focuses on the reduction of swelling and effusion and restoration of range of movement. Exercise such as isometric knee extension is introduced as well to reduce the rate of muscle control.

Strength and Conditioning phase (Week 4-12); Aims:

  • Full range of motion and minimal swelling
  • Unilateral knee exercises
  • Achieving 80% muscle strength of the non injured knee

Once the swelling has reduced significantly, full extension restored with flexion achieved to about 100-120 degrees, and normal gait almost regained, the athlete is then put through other strengthening exercises which can including cycling, leg press, step downs, mini squats (0-45 degrees flexion). All these exercises should be done with both legs, with emphasis on smoothness of execution of movement. The athletes are loaded with low weights at first and then progressed gradually to higher weights with low repetitions. Cardiovascular endurance exercises are also started at this place.

Unilateral knee exercises can be started once the athlete has sufficient muscle control to do a single knee squat of 0-45 degrees flexion. Once the quadriceps and hamstring muscles of the operated knee can achieve about 80% strength of the uninvolved knee, it is time to move on the next phase. The strength of the uninvolved knee, it is time to move on to the next phase. The strength of the knee can be easily gauged by testing the knee on a leg press machine, comparing the weights that be achieved by each knee on a single set of 15 repetitions. A much more accurate test of the strength of the muscles can be done using the isokinetic machine.

The isokinetic strength test is widely used in sports clinics to evaluate the strength of muscles pre and post operatively. However the main drawbacks of the test are that the data does not accurately determine the different performance between athletes of varying skill levels and do not correlate strongly with functional tasks.

Sports Conditioning Phase (Week 12 onwards); Aims:

  • Achieve 90-100% muscle strength in quadriceps and hamstrings
  • Achieve 90-100% in functional testing
  • Athlete is able to perform sports specific movements with ease

Once the athlete can achieve 80% of quadriceps muscle strength and good control over single leg exercise, the next step will be to do functional tests to gauge the performance of the knee. Functional tests have been devised for athletes who has ACL reconstruction done. The tests include jumps, hops, agility and quickness in navigating turns. Various components of physical fitness listed above are tested i.e agility, balance, power and co-ordination. As such, the tests are also suitable to be applied to chart the progress of athletes recovering from post-operative meniscal repair, menisectomy and other ligamentous injury. Being functional, the tests would also be more meaningful as they mimic the movements that would be performed during the sport itself. At this phase, the athletes will be continuing to increase the basic muscle strength through the similar exercises listed in phase 2. These strengthening exercises will form the foundation from which the athletes will be trained in the other components.

Balance is a state of equilibrium, the ability to control the body’s position at rest or in motion. The athlete starts his balance training through balancing on 1 leg on a flat surface before progressing to balancing on unstable surface such as a wobble board. Subsequently, single leg hopping exercises will be introduced and progressed to multi-directional movements, where the level of difficulty is increased.

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Pain Free Knee, Is it Possible?

One would have some experiences with knee problems at some point in life regardless of your activity level. Do we really have to live with this pain in the knee? No. Knee pain in a common problem that affects people of all ages. It occurs due to a few different reasons and causes.

Knee Injuries

– Anterior Cruciate Ligament (ACL) tear, Medial & Lateral Collateral Ligament (MCL and LCL) Tear, Meniscal Tear and/or Cartilage Tear are injuries that could result in knee pain. Most of these injuries happen as a result of a shearing or twisting action on tke knee causing laxity and presence of loose bodies or knee movement limitations. People with ACL tears tend to present with higher risk of having knee osteoarthritis where the cartilages are worn off.

– There are two C-shape meniscus in the knee joint that acts as shock absorbers between the thigh and shin bone and as stabilizers of the knee. Meniscus tear comes about when there is sudden twisting and compression of the knee or there is repetitive stress to the knee and this injury can occur together with an ACL tear, and increase the chances of arthritis changes in the knee joint. Medications will be given by your doctor to reduce any inflammatory reactions and physiotherapy is usually the treatment for any such tears. However, is cases where it is imminent to remove or repair the meniscus, surgical interventions such as meniscus repair will be done arthroscopically.

Patellar Tendinitis

A common overuse injury, commonly termed “jumper’s knee” as it occurs mostly in people who don’t jump due to the following reasons:

– Malaligment of knee cap, thigh bone & shin bone

– Rapid weight gain resulting in excessive strain on the tendon.

– Muscle imbalance-tightness of Quadriceps (muscle on front of thigh), tightness of hamstrings (muscle on front of thigh), tightness of hamstring (muscle on back of thigh) and / or weakness of VMO muscle (one of the four muscles of the quadriceps).

In some cases, your doctor may prescribe medications to reduce the inflammation & pain or administer other techniques like ESWT (Extracorporeal Shock Wave Therapy), PRP (Platelet Rich Plasma treatment) to help promote healing in the tendon.

Knee Degeneration

– Osteoarthritis (OA) is one of the most common degenerative problems of the knee and it can affect people of all ages. It occurs due to the wear and tear of the cartilages in the knee joint and is therefore dependent on the amount of impact that the knee takes on with activities, Customised insules can also help elleviate any pain that occurs because of changes in joint allignment thus reduces the impact on the worn our portion of the knee.

– Proper physiotherapy treatments and use of customized insoles greatly reduces the need to have any surgical interventions especially if administered early.

– In certain cases, cartilage degeneration could have occured for a long time, and without proper management this condition canbe debilitating with loss of ROM.

– Rheumatoid arthritis( (RA) is the other type of arthritis that can affect any joint in your body as it is an autoimmune condition. It is a chronic problem that has to be managed by medications, rest and physiotherapy.

Knee Malalignment Problems

– Illiotibial band syndrome occurs when the band on the outer part of your thigh bone becomes too tight and rubs against the outer knee.

– Patellofemoral pain (PFP) syndrome is the pain one experiences in the knee cap due to malaligment of the knee cap and is also experienced in people with OA knee. In most cases, PFP can be resolved with a pair of customized insoles, mobilisation techniques, taping techniques and proper strengthening & stretching exercises.

– Hip & foot allignment problems can also cause knee pain due to changes in loading on the knee. Prople with flat feet or high arch problem may also experience knee pain. In some cases, the lowering of foot arch may be caused by massive weight gain and weight loss programs as precribed. In most cases, a good pair of customized insole and joint mobilisation helps to resolve the whole issue. Stretching & stengthening exercises prescrived by your physiotherapist is beneficial to prevent any recurrence.

As in any other injuries, always consult a doctor or a physiotherapist to find out the root cause of your problem and receive the appropriate treatment forit.

Stop Your Knee Pain Today! Call +65 6471 2744 for Appointment

About Knee Pain

What Do the Knees Do?

The knees provide stable support for the body. They also allow the legs to bend and straighten. Both flexibility and stability are needed to stand, walk, run, crouch, jump, and turn. Other parts of the body help the knees do their job. These are:

  • Bones
  • Cartilage
  • Muscles
  • Ligaments
  • Tendons

Who Gets Knee Problems?

Men, women, and children can have knee problems. They occur in people of all races and ethnic backgrounds.

What Causes Knee Problems?

Mechanical knee problems can be caused by:

  • A direct blow or sudden movements that strain the knee
  • Osteoarthritis in the knee, resulting from wear and tear on its parts.

Inflammatory knee problems can be caused by certain rheumatic diseases, such as rheumatoid arthritis and systemic lupus erythematosus (lupus). These diseases cause swelling that can damage the knees permanently.

How Are Knee Problems Diagnosed?

Doctors diagnose knee problems by using:

  • Medical history
  • Physical examination
  • Diagnostic tests (such as x rays, bone scan, CAT scan, MRI, arthroscopy, and biopsy).

Arthritis in the Knees

The most common type of arthritis of the knee is osteoarthritis. In this disease, the cartilage in the knee gradually wears away. Treatments for osteoarthritis are:

  • Medicines to reduce pain, such as aspirin and acetaminophen
  • Medicines to reduce swelling and inflammation, such as ibuprofen and nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Exercises to improve movement and strength
  • Weight loss.

Rheumatoid arthritis is another type of arthritis that affects the knee. In rheumatoid arthritis, the knee becomes inflamed and cartilage may be destroyed. Treatment includes:

  • Physical therapy
  • Medications
  • Knee replacement surgery (for a seriously damaged knee).

Cartilage Injuries and Disorders

Chondromalacia (KON-dro-muh-lay-she-uh) occurs when the cartilage of the knee cap softens. This can be caused by injury, overuse, or muscle weakness, or if parts of the knee are out of alignment. Chondromalacia can develop if a blow to the knee cap tears off a piece of cartilage or a piece of cartilage containing a bone fragment.

The meniscus (meh-NISS-kus) is a C-shaped piece of cartilage that acts like a pad between the femur (thigh bone) and tibia (shin bone). It is easily injured if the knee is twisted while bearing weight. A partial or total tear may occur. If the tear is tiny, the meniscus stays connected to the front and back of the knee. If the tear is large, the meniscus may be left hanging by a thread of cartilage. The seriousness of the injury depends on the location and the size of the tear.

Treatment for cartilage injuries includes:

  • Exercises to strengthen muscles
  • Electrical stimulation to strengthen muscles
  • Surgery for severe injuries.

Illustration depicting a lateral view of the knee, showing the location of: Quadriceps tendon; Patella; Lateral collateral ligament; articular cartilage; Patellar tendon; Meniscus; Tibia; Medial collateral ligament; Anterior cruciate ligament; Posterior cruciate ligament; and Femur.

Ligament Injuries

Two commonly injured ligaments in the knee are the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). An injury to these ligaments is sometimes called a “sprain.” The ACL is most often stretched or torn (or both) by a sudden twisting motion. The PCL is usually injured by a direct impact, such as in an automobile accident or football tackle.

The medial and lateral collateral ligaments are usually injured by a blow to the outer side of the knee. This can stretch and tear a ligament. These blows frequently occur in sports such as football or hockey.

Ligament injuries are treated with:

  • Ice packs (right after the injury) to reduce swelling
  • Exercises to strengthen muscles
  • A brace
  • Surgery (for more severe injuries).

Tendon Injuries and Disorders

The three main types of tendon injuries and disorders are:

  • Tendinitis and ruptured tendons
  • Osgood-Schlatter disease
  • Iliotibial band syndrome

Tendon injuries range from tendinitis (inflammation of a tendon) to a ruptured (torn) tendon. Torn tendons most often occur from:

  • Overusing a tendon (particularly in some sports). The tendon stretches like a worn-out rubber band and becomes inflamed.
  • Trying to break a fall. If thigh muscles contract, the tendon can tear. This is most likely to happen in older people with weak tendons.

One type of tendinitis of the knee is called jumper’s knee. In sports that require jumping, such as basketball, the tendon can become inflamed or can tear.

Osgood-Schlatter disease is caused by stress or tension on part of the growth area of the upper shin bone. It causes swelling in the knee and upper part of the shin bone. It can happen if a person’s tendon tears away from the bone, taking a piece of bone with it. Young people who run and jump while playing sports can have this type of injury.

Iliotibial band syndrome occurs when a tendon rubs over the outer bone of the knee causing swelling. It happens if the knee is overused for a long time. This sometimes occurs in sports training.

Treatment for tendon injuries and disorders includes:

  • Rest
  • Ice
  • Elevation
  • Medicines such as aspirin or ibuprofen to relieve pain and reduce swelling
  • Limiting sports activity
  • Exercise for stretching and strengthening
  • A cast, if there is a partial tear
  • Surgery for complete tears or very severe injuries.

Other Knee Injuries

Osteochondritis dissecans (OS-tee-oh-kon-DRI-tis DIS-secans) occurs when not enough blood goes to part of the bone under a joint surface. The bone and cartilage gradually loosen and cause pain. Some cartilage may break off and cause sharp pain, weakness, and locking of the joint. A person with this condition may develop osteoarthritis. Surgery is the main treatment.

  • If cartilage fragments have not broken loose, a surgeon may pin or screw them in place. This can stimulate new blood flow to the cartilage.
  • If fragments are loose, the surgeon may scrape the cavity to reach fresh bone and add a bone graft to fix the fragments in position.
  • Research is being done to investigate cartilage and tissue transplants.

Plica (PLI-kah) syndrome occurs when bands of tissue in the knee called plicae swell from overuse or injury. Treatments for this syndrome are:

  • Medicines such as aspirin or ibuprofen to reduce swelling
  • Rest
  • Ice
  • Elastic bandage on the knee
  • Exercises to strengthen muscles
  • Cortisone injection into the plicae
  • Surgery to remove the plicae if the first treatments do not fix the problem.

What Kinds of Doctors Treat Knee Problems?

Injuries and diseases of the knees are usually treated by an orthopaedist (a doctor who treats problems with bones, joints, ligaments, tendons, and muscles).

How Can People Prevent Knee Problems?

Some knee problems (such as those resulting from an accident) can’t be prevented. But many knee problems can be prevented by doing the following:

  • Warm up before playing sports. Walking and stretching are good warm-up exercises. Stretching the muscles in the front and the back of the thighs is a good way to warm up the knees.
  • Make the leg muscles strong by doing certain exercises (for example, walking up stairs, riding a stationary bicycle, or working out with weights).
  • Avoid sudden changes in the intensity of exercise.
  • Increase the force or duration of activity slowly.
  • Wear shoes that fit and are in good condition.
  • Maintain a healthy weight. Extra weight puts pressure on the knees.

What Types of Exercise Are Best for Someone With Knee Problems?

Three types of exercise are best for people with arthritis:

  • Range-of-motion exercises. These exercises help maintain or increase flexibility. They also help relieve stiffness in the knee.
  • Strengthening exercises. These exercises help maintain or increase muscle strength. Strong muscles help support and protect joints with arthritis.
  • Aerobic or endurance exercises. These exercises improve heart function and blood circulation. They also help control weight. Some studies show that aerobic exercise can reduce swelling in some joints.

Knee Sprain

Knee sprain is when ligaments in the knee are stretched or torn. There are 4 main ligaments in the knee that can be sprained, they are:

ACL – anterior cruciate ligament
PCL – posterior crciate ligament
MCL – medial collateral ligament
LCL – lateral collateral ligament

Grade 1 – Mild stretch/micro tearing of the ligaments. There is mild swelling and tenderness over the ligament if it is the MCL/LCL (unable to touch ACL/PCL)

Grade 2 – Moderate stretch/incomplete tearing of the ligaments. There is moderate swelling and tenderness over the ligament and usually some bruising occurs. Laxity is felt in the ligament, however there is an end feel when testing. The knee feels unstable to the patient.

Grade 3 – Complete tear of the ligaments in the knee. There is profuse swelling in the knee immediately. Severe laxity is felt when testing the ligament and the joint is very unstable.

Method Of Injury
– Mainly occur from a traumatic incident, often with the leg planted on the ground.

MCL – Direct blow to the outside of the knee
– Pain felt on the inside of the knee
– Able to “touch” the pain

LCL – Direct blow to the inside of the knee
– Pain felt on the outside of the knee
– Able to “touch” the pain

ACL – Direct blow to the front of the thigh with the leg planted
– Pivot of the body over the planted knee
– Hyperextension of knee
– Unable to touch the pain
– Usually a “pop” is felt or heard

PCL – Direct blow to the back of the thigh with the leg planted
– Direct blow to the tibia with the leg planted
– Hyperextension of knee
– Hyperflexion of the knee

Treatment – All knee sprains should be initially treated by the PIER principle (Pressure, Ice, Elevation, Rest)

MCL – Strengthen surrounding muscles
– Surgery is typically not performed on MCL injuries
– Hinged knee brace to support and protect from further injury

LCL – Strengthen surrounding muscles
– Surgery is typically needed to repair the ligament, as it does not have very good healing abilities
– Hinged knee brace to support and protect from further injury

ACL – Strengthen surrounding muscles, specifically the hamstrings
– Surgery is required to repair the ligament
– Lengthy recovery time after surgically repaired
– Custom knee brace is required to protect the ligament from re-injury

PCL – Strengthen surrounding muscles, specifically the quadriceps
– Surgery is not necessary for proper return to athletics, however reconstruction is recommended to prevent secondary complications
– Custom knee brace is required to protect against re-injury of the ligament

Stop your knee pain and get it checked, Call +65 6471 2744 / Email to: info@boneclinic.com.sg

Knee Injuries

There are many different structures inside and outside your knee. These include ligaments, which connect your bones together, articular cartilage, which covers the end of your shin bone and thigh bone in your knee joint, and a crescent-shaped disc called a meniscus. This is made from cartilage and acts as a shock absorber and helps to stabilise your knee. Injury to your knee may damage any one of these structures.

Knee ligament injuries

Your knee ligaments help to keep your knee stable.

The medial collateral and lateral collateral ligaments are found on either side of your knee joint, and act to limit the amount it can move from side to side. You can sprain or tear your medial collateral ligament if you twist your leg while it’s straightened, for example, when being tackled in rugby. Your lateral collateral ligament isn’t usually damaged on its own, but you may need to have it repaired if you have damaged other ligaments.

Your anterior cruciate ligament and posterior cruciate ligament form a cross (cruciate) inside your knee. They help to keep your knee stable when the joint is moving backwards and forwards. Anterior cruciate ligament injuries are one of the most serious types of knee injury.

If you have injured your medial collateral or lateral collateral ligaments, your doctor may grade your injury according to how severe the damage is.

  • Grade 1 is a stretch of the ligament without tearing.
  • Grade 2 is a partial tear of the ligament.
  • Grade 3 is a complete tear of the ligament.

Other soft tissue injuries

Apart from ligaments there are other soft tissues around your knee that can be injured. Soft tissue means any tissue in your body that isn’t bone.

You may tear the meniscus in your knee. You can damage it if you play a sport that involves twisting your upper leg while your foot is planted on the floor. As you get older, your meniscus may become slightly thinner or have micro tears (degenerates). This makes it more likely to tear after a very minor injury.

If you use your knee a lot, for example if you run, you can irritate or tear the tendon that connects your kneecap (patella) to your thigh muscle. This tendon is called the patella tendon and the condition is patella tendonitis.

Symptoms of knee injuries

You may feel or hear a popping or snapping sensation at the time of the injury. You may also find that you can’t stand properly on the affected leg, or put your full weight on it.

The symptoms for most ligament injuries will be similar, no matter which one has been damaged. These may include:

  • pain
  • swelling
  • instability – you may feel like your knee is giving way

You may feel a tearing sensation and severe pain if you injure the meniscus in your knee. Pain may develop towards the inside, outside or back of your knee joint (depending on which menisus you injured) and you may see some swelling.

If you have any of these symptoms, visit your GP or physiotherapist for advice.

Causes of knee injuries

You may injure your knee if:

  • an impact moves your knee beyond its usual range of movement, for example if you have a fall or land awkwardly
  • you play a sport that combines running, jumping and stopping with quick changes of direction, such as football
  • you have a condition such as arthritis or gout, which can affect your joints, or are very overweight, which can put pressure on your knees
  • your knees hit the dashboard in a car accident – posterior cruciate ligament damage is sometimes called the ‘dashboard injury’ as this is often how it occurs
  • you wear footwear that doesn’t match the shape of your feet or have poor training methods or flexibility, which can lead to overuse injuries of your knee

Diagnosis of knee injuries

Your doctor or physiotherapist will ask about your symptoms and examine you. This may include feeling for fluid in your knee joint by pressing gently around your kneecap. He or she will also ask you to describe how your injury happened, where your pain is and what type of pain it is.

Your doctor or physiotherapist may ask you to walk, sit or lie down so he or she can test for injury to your knee ligaments or soft tissues. He or she will bend and flex your knee and move your leg into different positions. Your physiotherapist may also ask you to step, squat or hop.

Your doctor may refer you for other tests in a hospital or clinic. These may include an MRI or ultrasound scan, and occasionally an X-ray. These tests can help to diagnose more complicated or severe injuries.

Treatment of knee injuries

There are different types of treatment that your doctor or physiotherapist may suggest, depending on the type and severity of the damage to your knee. It’s important to be patient when recovering from a knee injury. Your injury may take time to fully repair itself, so you may not be able to do all the things you are used to doing for some time.

Self help

You should follow the PRICE procedure to manage any type of soft tissue injury to your knee. PRICE stands for the following.

  • Protection. Protect your injury from further harm.
  • Rest. Rest the injury for the first two to three days, then reintroduce movement so you don’t lose too much muscle strength.
  • Ice. Apply a cold compress such as ice or a bag of frozen peas wrapped in a towel to help reduce swelling and bruising. Do this for 15 to 20 minutes every two to three hours. Don’t apply ice directly to your skin as it can damage your skin.
  • Compression. Compress the joint by bandaging it to support the injury and help decrease swelling. Don’t leave this on while you sleep.
  • Elevation. Elevate your knee by resting it above the level of your heart and keeping it supported.

There are certain things you should not do in the first three days after your injury so you don’t damage your knee further. These can be remembered as HARM.

  • Heat. This includes having a hot bath or using a heat pack.
  • Alcohol. Drinking alcohol can increase bleeding and swelling in the affected area.
  • Running or other forms of exercise.
  • Massaging the injured knee. This can cause more swelling or bleeding.

If you’re having difficulty bearing weight on your knee, you may need to use crutches or wear a brace to make sure that you keep weight off the affected knee.


You can buy over-the-counter painkillers such as paracetamol to treat mild and moderate pain. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and ketoprofen can help to reduce inflammation and swelling, as well as relieve pain. NSAIDs are available as gels, creams and sprays that you can put directly onto your skin and gently massage in, as well as tablets or capsules that you take by mouth.

Your doctor may prescribe stronger painkillers if your pain is severe. Always read the patient information that comes with your medicine and if you have questions, ask your pharmacist or doctor for advice.


If your injury is more severe or complex, your doctor may refer you to a physiotherapist (a health professional who specialises in movement and mobility). You can also choose to see a physiotherapist privately. He or she will develop a programme of rehabilitation exercises to gradually strengthen your knee and stretch your muscles. These exercises will vary depending on the type of injury you have and how severe it is. Your physiotherapist may also use various techniques to help speed up the healing of your knee.

Braces or strapping to support your knee are occasionally used during rehabilitation, usually when an injury has been severe.


For some types of knee injury, our doctor or physiotherapist may recommend that you have surgery to repair the injury to your knee – especially if other forms of treatment haven’t worked. Your doctor will refer you to an orthopaedic surgeon for assessment.

The surgeon is more likely to suggest surgery if you have one of the following injuries.

  • You have torn your anterior cruciate ligament and you do a lot of sport or have also torn the meniscus or your medial collateral ligament. Anterior cruciate ligament reconstruction involves taking a piece of tendon (usually from your hamstring) to replace the damaged ligament.
  • Your knee remains painful or locks after an injury to your meniscus.

Rarely, surgery may involve opening up your knee joint to repair it, or you may be able to have a type of keyhole surgery called knee arthroscopy to access the damaged area of your knee.

Prevention of knee injuries

There are some precautions you can take to try to reduce the risk of damaging your knee ligaments.

  • Exercise regularly to maintain a good level of fitness. This will mean your muscles are stronger and better able to support your joints, including your knees. If you haven’t been active for a while, start gently and gradually increase the intensity.
  • Spend five to 10 minutes warming up before exercise to increase blood flow to your muscles and reduce the chance of an injury. Many sports professionals advise stretching your muscles after warming up and again after cooling down; however, the benefit of stretching before or after exercise to prevent soft tissue injuries is unproven.
  • Wear correct footwear. There are many different models of trainers available, but the best is one that matches the shape of your feet. If you’re not sure, it’s a good idea to go to a specialist sports shop and ask for advice.

To Check on Your Knee, Call us at +65 6471 2744 (24 Hours) / info@boneclinic.com.sg


Knee Pain While Running

Knee pain while running can quickly turn an enjoyable workout into a painful chore. Knee pain is one of the most common injury complaints of runners, and can derail training programs for weeks and sometimes even months. But not all knee pains are the same, as there are multiple causes, symptoms, and treatments that go with each of these. Check out the injuries below to see which type of knee injury may pertain to you; what you can do to avoid it; and how best to treat it. As with any injury, consult a medical professional for treatment and advice as they can better ascertain your exact injury and the best treatment alternative.

Knee Pain While Running

The knee is one of the most complex joints in our body. It’s the juncture where four bones come together (femur, tibia, fibula, and patella. It’s supported by a cast of tendons, ligaments, and cartilage, and it is the location where out Iliotibial Band (“IT band”) connects our lower leg to our pelvis at a point just below the knee. So suffice to say that knee injuries from running could come from a variety of sources. Here are just a few causes of knee pain for runners:

Runner’s Knee is the more popular term that refers to Chondromalacia of the knee cap (patella). This can be caused when there’s an imbalance of the muscles or overpronation. Symptoms include a pain around the knee, and frequent “pop” or “crack” noises as the knee cap seems to be almost off track. This also may be accompanied by swelling and inflammation around the knee cap as the cartilage becomes soft, and irritated, leading to potential deterioration.

Some ways to counteract this condition are strength training exercise that build the hamstring, quadriceps, thigh and calve muscles. If overpronation is deemed a possible cause, then orthotics or shoes that promote better running mechanics may help alleviate this injury.

Knee Pain While Running – Patella Tendonitis

The knee cap (patella) connects to our lower leg by the patellar tendon. Overuse and stress of this tendon can lead to inflammation and eventually tendonitis. This injury will cause pain and stiffness below the knee cap and may exhibit some mild swelling. I had this injury during my senior year of high school cross country, and thankfully was able to treat this with a few weeks of rest and leg strengthening exercises. As with most injuries, the R.I.C.E. acronym is a good precautionary first measure: Rest-Ice-Compression-Elevation. No one likes to take days off especially runner, but rest is usually part of almost all successful treatment solutions.

Knee Pain While Running – Meniscus Degradation

Our knee joints have crescent-shaped cartilage shock absorbers for our knee cap that form our meniscus. This cushion can become torn from excessive wear or twisting movements of the knee. Minor strains and tears will likely be prescribed the R.I.C.E. treatment, while more serious injuries may require arthroscopic surgery. Pay attention to warning signs…and when in doubt…take a rest day and consult a sports medicine physician if the knee pain while running is severe.

Knee Pain While Running – Iliotibial Band Syndrome

If your knee pain while running is on the outside of your knee, you may be suffering from IT band syndrome. This can occur when the IT band, which stretches from our pelvis down to our lower knee, becomes too taught. Ways to prevent this injury are running on flat surfaces; gradually increasing mileage; and stretching to increase flexibility. All of these measures can help reduce the stress on the IT band and may reduce the pain and chances of future injury.

Experiencing Knee Pain while running? Call us to find out why and what’s the cure? 24 Hours Hotline: +65 6471 2744 or SMS to +65 9235 7641 for appointment

9 Tips to avoid Knee Pain and Injuries

Knee pain is often caused by either a one-time acute injury or repetitive motions that stress the knee over time, particularly as we age. There are some steps you can take to avoid knee painand injuries.

“One of the most common things that causes knee injuries is the runner’s stretch,” says Robert Gotlin, DO, director of sports rehabilitation at Beth Israel Medical Center in New York City. “That’s when you grab your foot, bringing heel to butt. We all do it, but it’s one of the things that tends to increase knee pain. By bending the knee all the way, the kneecap gets jammed into the bones below it.”

The runner’s stretch can set the stage for chondromalacia patella, a condition where the cartilage under your knee cap becomes softened, which is the most common form of knee pain. By repeatedly jamming your kneecap, you are promoting more chondromalacia.

Generally, the best knee injury prevention starts with becoming familiar with your own body and learning how to exercise correctly. If your knees are the type that are prone to chronic pain from arthritis, for example, impact-oriented exercise is not a good idea. Opt for an elliptical machine rather than the treadmill at the gym.

Tips for Avoiding Knee Injuries
You can avoid knee pain and injuries by doing the following:

  1. Maintain your weight. Because extra weight can increase your chances of developing osteoarthritis, maintain a weight that’s appropriate for your size and age to decrease stress on your knees and to avoid increased chances for knee injuries.
  2. Wear sensible shoes with a good fit. It will help you to maintain proper leg alignment and balance, ultimately preventing knee injuries.
  3. Warm up. Before starting any exercise, warm up and then do stretches. If you stretch muscles in the front and back of your thighs, it decreases tension on your tendons, ultimately relieving pressure on the knees.
  4. Do low-impact exercise. At the gym, opt for a rowing machine or a cross-country skiing machine. Both offer a strong workout with low impact to your knees.
  5. Swim or walk. When exercising outside of the gym, opt for swimming or walking.
  6. Weight train. Strengthen your leg muscles to better support your knees and avoid injuries by working out with weights. But be sure to consult with an expert first on the right way to life weights to prevent knee pain.
  7. Don’t decrease your activity. A decrease in activity will lead to weakness, increasing your chances of injuries.
  8. Don’t suddenly change the intensity of your exercise. Build up gradually to avoid knee pain.
  9. Consider physical therapy. If you already have a knee injury, visit a physical therapist who can help to set up an appropriate exercise regime.

You may notice that some people with knee problems wrap their knees during exercise or at other times. People generally do this because it feels good. While it won’t hurt your knee, it won’t help to avoid an injury. If you wrap, be sure to avoid wrapping too tightly, because that can also cause a knee problem.

Knee pain caused by Extra Weight? ~ Best Diet Tips

Tip No. 1: Drink plenty of water or other calorie-free beverages.

Before you tear into that bag of potato chips, drink a glass of water first. People sometimes confuse thirst with hunger, so you can end up eating extra calories when an ice-cold glass of water is really all you needed. If plain water doesn’t cut it, try drinking flavored sparkling water or brewing a cup of fruit-infused herbal tea.

Tip No. 2: Be choosy about nighttime snacks.

Mindless eating occurs most frequently after dinner, when you finally sit down and relax. Snacking in front of the TV is one of the easiest ways to throw your diet off course. Either close down the kitchen after a certain hour, or allow yourself a low-calorie snack, like a 100-calorie pack of cookies or a half-cup scoop of low-fat ice cream.

Tip No. 3: Enjoy your favorite foods.

Instead of cutting out your favorite foods altogether, be a slim shopper. Buy one fresh bakery cookie instead of a box, or a small portion of candy from the bulk bins instead of a whole bag. You can still enjoy your favorite foods — the key is moderation.

Tip No. 4: Eat several mini-meals during the day.

If you eat fewer calories than you burn, you’ll lose weight. But when you’re hungry all the time, eating fewer calories can be a challenge. “Studies show people who eat 4-5 meals or snacks per day are better able to control their appetite and weight,” says obesity researcher Rebecca Reeves, DrPH, RD. She recommends dividing your daily calories into smaller meals or snacks and enjoying most of them earlier in the day — dinner should be the last time you eat.

Tip No. 5: Eat protein at every meal.

Protein is the ultimate fill-me-up food — it’s more satisfying than carbs or fats and keeps you feeling full for longer. It also helps preserve muscle mass and encourages fat burning. So be sure to incorporate healthy proteins like lean meat, yogurt, cheese, nuts, or beans into your meals and snacks.

Tip No. 6: Spice it up.

Add spices or chiles to your food for a flavor boost that can help you feel satisfied. “Food that is loaded with flavor will stimulate your taste buds and be more satisfying, so you won’t eat as much,” says American Dietetic Association spokeswoman Malena Perdomo, RD. When you need something sweet, suck on a red-hot fireball candy. It’s sweet, spicy, and low in calories.

Tip No. 7: Stock your kitchen with healthy, convenient foods.

Having ready-to-eat snacks and meals-in-minutes on hand sets you up for success. You’ll be less likely to hit the drive-through or order a pizza if you can throw together a healthy meal in five or 10 minutes. Here are some essentials to keep on hand: frozen vegetables, whole-grain pasta, reduced-fat cheese, canned tomatoes, canned beans, pre-cooked grilled chicken breast, whole grain tortillas or pitas, and bags of salad greens.

Tip No. 8: Order children’s portions at restaurants.

Ordering a child-size entree is a great way to cut calories and keep your portions reasonable. This has become such a popular trend that most servers won’t bat an eye when you order off the kids’ menu. Another trick is to use smaller plates. This helps the portions look like more, and if your mind is satisfied, your stomach likely will be, too.

Tip No. 9: Swap a cup of pasta for a cup of vegetables.

Simply by eating less pasta or bread and more veggies, you could lose a dress or pants size in a year. “You can save from 100-200 calories if you reduce the portion of starch on your plate and increase the amount of vegetables,” says Cynthia Sass, RD, a spokeswoman for the American Dietetic Association.

Tip No. 10: Always eat breakfast.

It seems like an easy diet win: Skip breakfast and you’ll lose weight. Yet some studies show the opposite can be true. Not eating breakfast can make you hungry later, leading to too much nibbling and binge eating at lunch and dinner. To lose weight — and keep it off — always make time for a healthy morning meal, like high-fiber cereal, low-fat milk, and fruit.

Tip No. 11: Include fiber in your diet.

Fiber aids digestion, prevents constipation, and lowers cholesterol — and can help with weight loss. Most Americans get only half the fiber they need. To reap fiber’s benefits, most women should get between 21-25 grams daily, while men need about 30-38 grams — nearly twice the current national average. Good fiber sources include oatmeal, beans, whole grain foods, and a variety of fruits and vegetables.

Tip No. 12: Clean the cupboards of fattening foods.

If you have chips in the pantry and ice cream in the freezer, you’re making weight loss harder than it has to be. Reduce temptation by purging the cupboards of fattening foods. Want an occasional treat? Make sure you have to leave the house to get it — preferably by walking.

Tip No. 13: Lose weight slowly.

If you’re losing weight but not as fast as you’d like, don’t get discouraged. Dropping pounds takes time, just like gaining them did. Experts suggest setting a realistic weight loss goal of about one to two pounds a week. If you set your expectations too high, you may give up when you don’t lose weight fast enough. Remember, you start seeing health benefits when you’ve lost just 5%-10% of your body weight.

Tip No. 14: Weigh yourself once a week.

People who weigh themselves regularly tend to have more weight loss success. But most experts suggest weighing yourself only once a week, so you’re not derailed by daily fluctuations. When you weigh yourself, follow these tips: Weigh yourself at the same time of day, on the same day of the week, on the same scale, and in the same clothes.

Tip No. 15: Get enough sleep.

When you’re sleep deprived, your body overproduces the appetite-stimulating hormone ghrelin but under-produces the hormone leptin, which tells you when you’re full. Getting enough sleep may make you feel rested and full and keep you from doing unnecessary snacking.

Tip No. 16: Understand portion sizes.

We’re so used to super-sizing when we eat out that it’s easy to carry that mind-set home. To right-size your diet, use a kitchen scale and measuring cups to measure your meals for a week or two. Use smaller plates and glasses to downsize your portions. Split restaurant servings in half — making two meals out of one big one. Portion out snack servings instead of eating them directly from the container.

Tip No. 17: Eat more fruits and vegetables.

The best “diet” is one where you get to eat morefood, not less. If you eat more fruits and vegetables, you shouldn’t feel as hungry because these nutrient-rich foods are also high in fiber and water, which can give you a feeling of fullness. Snacking can be a good thing as long as you choose smart snacks.

Tip No. 18: Limit alcohol to weekends.

Alcohol contains empty calories: a five-ounce glass of wine has 125, a bottle of beer about 153. Because our bodies don’t use those calories well, they usually get converted directly into fat. If you enjoy an occasional drink, consider a compromise. Enjoy your favorite alcoholic beverage on weekends only, with just one drink for women per day, two for men.

Tip No. 19: Chew sugarless gum.

The next time you want to grab a fattening snack, reach for some sugar-free gum instead. Chewing some types of gum gives you fresh breath and can also help manage hunger, control snack cravings, and aid in weight loss. Although gum might make you eat less, it doesn’t mean you can stop eating right. A good diet and exercise are still important.

Tip No. 20: Keep a food diary.

A simple pen and paper can dramatically boost your weight loss. Studies show the act of writing down what you eat and drink tends to make you more aware of what, when, and how much you’re consuming — leading you to ultimately take in fewer calories. One study found that people who kept a food diary six days a week lost about twice as much as those who only kept a diary one day a week or less.

Tip No. 21: Celebrate success (but not with food).

You lost five pounds this month and walked every other day? Time to celebrate! Rewarding weight loss success really can encourage more success, so revel in your achievements. Buy a CD, take in a movie, and set a prize for the next milestone. Just don’t celebrate with a sundae or deep dish pizza.

Tip No. 22: Get help from family and friends.

Getting support can help you reach your weight loss goals. So tell family and friends about your efforts to lead a healthy lifestyle. Maybe they’ll join you in exercising, eating right, and losing weight. When you feel like giving up, they’ll help you, keep you honest, and cheer you on — making the whole experience a lot easier.

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